As health care costs continue to be a challenge and new advances in technology and service delivery proliferate the industry, the provision of high-quality and low-cost health care services to patients in ambulatory care facilities continues to be assessed. The development of specialty services (e.g., urgent care, retail/workplace clinics, infusion clinics, ambulatory surgery, rehabilitation, drug treatment, sleep centers, etc.) and advances in technology (e.g., dialysis, advanced imaging, cardiovascular, and radiation therapy) have led to the increased establishment of specialized ambulatory centers.

Over the years, Epstein Becker Green has played a significant role in advising clients throughout the country on a wide variety of regulatory, operational, and strategic business issues when developing and operating one or more of these types of ambulatory care facilities.

Services/Scope of Practice

Epstein Becker Green's broad range of services in this area include:

  • Working to align ambulatory care facilities with health systems, practitioners, payers/employers, and other stakeholders in light of the dynamic regulatory, reimbursement, and business environments
  • Negotiating private equity investments and conducting the due diligence for such private equity investors to determine an ambulatory care facility's compliance with government health program requirements
  • Providing legal counsel to minimize antitrust challenges of complex new corporate structures and contractual relationships
  • Assisting clients with reimbursement issues that are unique to free-standing ambulatory centers, including coding, coverage, payment, and enrollment issues
  • Drafting and implementing compliance plans specific to the needs of ambulatory care facilities
  • Assisting developers of new ambulatory care facilities in selecting and forming an operating entity for the project and preparing the applicable corporate documents
  • Drafting the prospectus and related offering documents for ambulatory care facility joint ventures
  • Negotiating business contracts, including agreements related to the provision of management services, billing and collection services, group purchasing, and other procurement arrangements
  • Analyzing the ownership structure and operations in light of federal and state fraud and abuse laws
  • Working with state regulatory agencies to procure any requisite certificates of need ("CONs") or licenses
  • Assisting clients in connection with survey, certification, and accreditation issues
  • Analyzing the tax consequences of nonprofit, tax-exempt organizations' participation in transactions and business relationships for the provision of ambulatory care
  • Representing clients before Congress, federal agencies, state legislatures, and state agencies on matters related to coverage and reimbursement issues affecting services rendered in ambulatory care facilities

Client Successes

  • Successfully advocating for appropriate payment and coverage for a group of ambulatory care providers
  • Assisting a client with the acquisition of over 50 ambulatory care centers in multiple states
  • Assisting a client with the development of an ambulatory center in compliance with a key state CON law exemption
  • Guiding a client through efficiently restructuring an ambulatory center
  • Assisting health systems, retailers, and employers with the establishment of ambulatory centers
  • Representing a large, multispecialty, multi-location group medical practice in its formation, growth, and compliance